Provider Demographics
NPI:1831123355
Name:RAY, EVE A (MFT)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3103
Mailing Address - Country:US
Mailing Address - Phone:818-788-3740
Mailing Address - Fax:818-905-5074
Practice Address - Street 1:15300 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 403
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:818-788-3740
Practice Address - Fax:818-905-5074
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist